Systematic review of interventions to reduce ethnic health inequalities in maternal and perinatal health in the UK.

INTRODUCTION

There are persistent ethnic health inequalities in maternal, neonatal and infant health outcomes in the UK. We sought to examine the available evidence on interventions to reduce ethnic health inequalities in maternal, neonatal and infant outcomes during pregnancy and up to the first year of the postnatal period.

METHOD

We conducted a systematic review searching MEDLINE, CINAHL, PsycINFO, Scopus and Web of Science (Social Science Index) databases, , Google Scholar and grey literature from relevant websites (from inception up to 11 August 2023). Interventions were mapped to a priori conceptual framework consisting of six levels (patient, provider, microsystem, organisation, community and policy). The 'template for intervention description and replication' checklist was used for intervention description. Results across studies were narratively synthesised and reported following the 'synthesis without meta-analysis' guidelines.

RESULTS

The electronic search identified 11 600 studies, with 16 studies describing eight types of interventions meeting the inclusion criteria. Studies were published between 1981 and 2022, predominantly in England (n=14), with a range of outcomes reported, including mode of delivery, place of birth, birth weight, stillbirth and preterm birth. The sample size varied from 21 to 20 651 participants with ethnic minority populations ranging from 18.9% to 100% of the study population. Studies mapped mainly to the patient level with policy least represented (14 and two, respectively). All studies described the reasons for the intervention with limited reporting on any modification during the study (n=2). Two studies with two types of interventions (early pre-eclampsia screening and midwifery continuity of care) demonstrated the potential for interventions to reduce ethnic health inequalities.

CONCLUSION

This review highlights the paucity of evaluated interventions to tackle ethnic health inequalities in maternal, neonatal/infant outcomes. Mapping interventions to the conceptual framework provides the evidence base for national policy interventions to tackle these long-protracted inequities.

PROSPERO REGISTRATION NUMBER

CRD42023453083.